Provider Demographics
NPI:1649843392
Name:MCCULLOUGH, JOSHUA (DNP, AGPCNP-BC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:DNP, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 VILLAGE LOOP DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-7995
Mailing Address - Country:US
Mailing Address - Phone:919-222-5381
Mailing Address - Fax:
Practice Address - Street 1:100 ROUNDTREE WAY
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-9978
Practice Address - Country:US
Practice Address - Phone:984-215-2650
Practice Address - Fax:919-542-6232
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014588363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner